Effectiveness of a perioperative pulmonary rehabilitation program following coronary artery bypass graft surgery in patients with and without COPD

Abstract

PurposeIt is unclear whether the effectiveness of pulmonary rehabilitation program (PRP) after cardiac surgery differs between patients with and without COPD. This study aimed to compare the effectiveness of PRP between patients with and without COPD undergoing coronary artery bypass graft (CABG) surgery.Patients and methodsWe retrospectively included patients who underwent CABG surgery and received 3-week PRP from January 2009 to December 2013. We excluded patients who underwent emergency surgery, had an unstable hemodynamic status, were ventilator dependent or did not complete the PRP. Demographics, muscle strength, degree of dyspnea, pulmonary function and postoperative complications were compared.ResultsSeventy-eight patients were enrolled (COPD group, n=40; non-COPD group, n=38). Maximal inspiratory pressure (MIP; −34.52 cmH2O vs −43.25 cmH2O, P<0.01; −34.67 cmH2O vs −48.18 cmH2O, P<0.01), maximal expiratory pressure (MEP; 32.15 cmH2O vs 46.05 cmH2O, P<0.01; 37.78 cmH2O vs 45.72 cmH2O, P<0.01) and respiratory rate (RR; 20.65 breath/minute vs 17.02 breath/minute, P<0.01; 20.65 breath/minute vs 17.34 breath/minute, P<0.01) in COPD and non-COPD groups, respectively, showed significant improvement, but were not significantly different between the two groups. Forced vital capacity (FVC; 0.85 L vs 1.25 L, P<0.01), forced expiratory volume in 1 second (FEV1; 0.75 L vs 1.08 L, P<0.01), peak expiratory flow (PEF; 0.99 L vs 1.79 L, P<0.01) and forced expiratory flow between 25% and 75% of vital capacity (FEF25–75; 0.68 L vs 1.15 L, P<0.01) showed significant improvement between postoperative Days 1 and 14 in the COPD group. FVC (1.11 L vs 1.36 L, P<0.05), FEV1 (96 L vs 1.09 L, P<0.05) and FEF25–75 (1.03 L vs 1.26 L, P<0.05) were significantly improved in the non-COPD group. However, only PEF (80.8% vs 10.1%, P<0.01) and FEF25–75 (67.6% vs 22.3%, P<0.05) were more significantly improved in the COPD group than in the non-COPD group.ConclusionPRP significantly improved respiratory muscle strength and lung function in patients with and without COPD who underwent CABG surgery. However, PRP is more effective in improving PEF and FEF25–75 in COPD patients.

Role of peri‐operative exercise in patients undergoing coronary artery bypass grafting

“…In keeping with the findings of the current study, it has been shown by other researchers too that after CABG, there is a significant reduction in respiratory muscle strength and, therefore, respiratory muscle training leads to improvement in objective parameters like maximal inspiratory and expiratory pressures, tidal volume, and respiratory capacity. 2,3 However, with regard to improved pain response, the authors' conclusions are in contradiction to what has been reported. 2 The authors used both the visual analog scale (VAS) as well as the Short-Form 36 (SF-36) to assess pain.…”

Outcomes in Patients With Severe Chronic Lung Disease Undergoing Index Cardiac Operations

“…Preoperative adjuncts including bronchodilator therapy, a short course of steroids, and pulmonary rehabilitation have also been suggested to reduce the rates of pulmonary complications. 19,20 Ultimately a combination of preoperative and perioperative strategies may allow for additive benefits to reduce postoperative pulmonary dysfunction and potentially improve longterm survival.…”

Rehabilitación Pulmonar en Pacientes con Enfermedad Pulmonar Obstructiva Crónica

“…El fortalecimiento del músculo diafragma como facilitador principal de la respiración, se menciona en el análisis de los artículos como el músculo de mayor importancia a fortalecer, teniendo en cuenta que al optimizar la función pulmonar mejora los volúmenes pulmonares, relación que se evidenció con la medición VEF1/CVF y FEF 25-75, parámetros evaluados previo y posterior a la intervención de la rehabilitación pulmonar (17,18) y que muestran mejoría significativa en los valores predichos. Rocha (19) describe la técnica de liberación manual del diafragma, al respecto, dice que mejoró significativamente la movilidad diafragmática en el transcurso del tratamiento; igualmente, se evidenció una mejoría significativa en la distancia de la caminata de 6 minutos.…”